“Is Focally Enhanced Active Inflammation of Brunner Glands a Sign of Crohn Duodenitis?”

Crohn disease (CD) not uncommonly involves the upper gastrointestinal tract, usually gastric antrum and proximal duodenum. The most consistent histopathologic manifestations of CD in duodenal biopsies are mucosal erosion, focal active inflammation, and granulomas. Since CD is a transmural inflammation and since duodenal biopsy may include submucosal Brunner glands, we aimed to find if CD has any specific histopathologic manifestations in Brunner gland lobules and their ducts compared to other duodenal inflammatory lesions. We carried out a retrospective review study over 6 years retrieving duodenal biopsy specimens in CD patients. We compared duodenal specimens involved by CD with other inflammatory lesions, for example, ulcerative colitis (UC), Helicobacter pylori-associated gastritis, non-Helicobacter gastritis, Celiac sprue, infections, and drugs. We found focal active duodenitis and erosion in CD cases and non-CD cases. Granulomas were found in CD cases. Five cases of CD showed inflammatory and degenerative changes of Brunner glands. Focal patchy active inflammation of only portion of submucosal Brunner gland lobule, mucosal Brunner glands, and their ducts was solely found in CD cases. This focally enhanced inflammation of Brunner glands was not found in other lesions. Whether this phenomenon of focal active “lobulitis” and “ductitis” is a specific sign of duodenal CD compared to UC and other inflammatory lesions warrants verification. We encourage endoscopists to include submucosal Brunner lobules in their duodenal biopsy samples and pathologists to look for these patterns of involvement particularly in patients suspected of CD.

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Uric Acid in Metabolic and Cerebrovascular Disorders: A Review

Current Vascular Pharmacology ◽

10.2174/1570161118666191217123930 ◽

2020 ◽

Vol 18 (6) ◽

pp. 610-618

Author(s):

Francesca Cortese ◽

Pietro Scicchitano ◽

Anna M. Cortese ◽

Giovanni Meliota ◽

Andrea Andriani ◽

...

Keyword(s):

Metabolic Syndrome ◽

Uric Acid ◽

Cerebrovascular Disorders ◽

Haemorrhagic Stroke ◽

Cerebrovascular Diseases ◽

Healthcare Research ◽

Cochrane Library ◽

Close Link ◽

Mesh Terms ◽

Active Inflammation

Background: Several studies showed a close link between metabolic syndrome (MetS), type 2 diabetes (T2DM) and cerebrovascular diseases. There is considerable debate regarding the role of uric acid (UA) as a risk factor in these conditions. Objective: The aim of this narrative review is to discuss the links between UA, MetS, T2DM and cerebrovascular disease. Methods: An extensive review has been conducted based on the scientific literature published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and Google Scholar from January to May 2019. Additional relevant studies published after the initial review were also considered during the period of June 2019-October 2019, during which, this manuscript was written. The Mesh Terms considered were: uric acid, antioxidant, oxidant, metabolic syndrome, diabetes, cerebrovascular diseases, stroke, haemorrhagic stroke, neurocognitive disorders, and their combinations. Results: The literature review shows a dose-dependent inflammatory action of UA, which occurs with serum concentrations >4 mg/dl (>0.24 mmol/l), representing one of the contributors to the chronic inflammatory process that underlies metabolic and cerebrovascular diseases. Conclusion: UA, which is associated with arterial hypertension and cardiovascular diseases, represents one of the indicators of oxidative homeostasis. Increasing concentrations represent a status of active inflammation which is observed with metabolic and cerebrovascular diseases.

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Complete heart block in cardiac sarcoidosis reversed by corticosteroid therapy: time course of resolution

BMJ Case Reports ◽

10.1136/bcr-2020-240834 ◽

2021 ◽

Vol 14 (3) ◽

pp. e240834

Author(s):

Anna Tomdio ◽

Huzaefah Syed ◽

Kenneth Ellenbogen ◽

Jordana Kron

Keyword(s):

Heart Block ◽

Time Course ◽

Cardiac Sarcoidosis ◽

Complete Heart Block ◽

Positron Emission ◽

Av Conduction ◽

Magnetic Resonance Imaging Mri ◽

High Level ◽

Active Inflammation ◽

Lateral Walls

A 53-year-old man was admitted for recurrent syncope and found to have complete heart block (CHB). Cardiac magnetic resonance imaging MRI) showed extensive patchy late gadolinium enhancement in the apical and lateral walls, consistent with cardiac sarcoidosis (CS) but no scar in the septum. A fluorodeoxyglucose (FDG)–positron emission tomography showed FDG uptake in the septum and basal lateral walls. Imaging suggested active inflammation in the septum affecting atrioventricular (AV) conduction but no irreversible fibrosis. Diagnosis of isolated CS requires a high level of suspicion and multidisciplinary teamwork involving heart failure specialists, electrophysiologists and rheumatologists. After specialist and patient discussion, treatment of the disease was initiated with prednisone 40 mg daily, 11 months after presenting with CHB. Three weeks later, ECG with pacing inhibited showed second-degree AV block Mobitz type II and 4 weeks later, AV conduction recovery. This highlights the importance of immediate therapy in reversing AV conduction abnormalities in CS.

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Fecal Calprotectin, CRP and Leucocytes in IBD Patients: Comparison of Biomarkers With Biopsy Results

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwaa009 ◽

2020 ◽

Author(s):

Barry D Kyle ◽

Terence A Agbor ◽

Shajib Sharif ◽

Usha Chauhan ◽

John Marshall ◽

...

Keyword(s):

Ulcerative Colitis ◽

Fecal Calprotectin ◽

Dependent Manner ◽

Ascending Colon ◽

C Reactive Protein ◽

Concentration Dependent Manner ◽

Reactive Protein ◽

Inflammatory Bowel ◽

Descending Colon ◽

Active Inflammation

Abstract Background This study aimed to compare fecal calprotectin (FC) levels with other commonly used parameters as part of patient care during evaluation for inflammatory bowel disease (IBD). Methods We recruited adult IBD patients with ulcerative colitis (UC) and Crohn’s disease (CD) and compared the results of the patient’s biopsy results (i.e., inflamed versus noninflamed) for six sites (i.e., ileum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum) with concentrations of C-reactive protein (CRP), total leucocytes and fecal calprotectin (FC). Results We found that FC was significantly elevated in a concentration-dependent manner that correlated with the number of active inflammation sites reported in biopsy. Although CRP and leucocyte measurements trended upwards in line with inflammation reported from biopsy, the results were highly variable and highlighted poor reliability of these biomarkers for indicating IBD inflammation. Conclusions These results strongly suggest that FC correlates best with biopsy reports and is a superior marker than CRP and leucocytes.

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Mycobacterial infection influences bone biomarker levels in patients with Crohn’s disease

Canadian Journal of Physiology and Pharmacology ◽

10.1139/cjpp-2017-0700 ◽

2018 ◽

Vol 96 (7) ◽

pp. 662-667 ◽

Cited By ~ 5

Author(s):

Amna Naser ◽

Ahmad Qasem ◽

Saleh A. Naser

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Mycobacterium Avium ◽

Disease Model ◽

Mycobacterial Infection ◽

Undercarboxylated Osteocalcin ◽

Healthy Cattle ◽

The Mean ◽

Mycobacterium Avium Subsp Paratuberculosis ◽

Active Inflammation

Patients with Crohn’s disease (CD) have higher risk for osteoporosis following decreased level of osteocalcin. We hypothesize that active inflammation following Mycobacterium avium subsp. paratuberculosis (MAP) infection results in elevation of undercarboxylated osteocalcin (ucOC) and downregulation of active osteocalcin in CD patients and cow-disease model (Johne’s disease). In this study, we measured ucOC, active osteocalcin, and calcium levels in sera from 42 cattle (21 infected with MAP and 21 healthy cattle), 18 CD patients, and 20 controls. The level of ucOC in MAP+ bovine samples was higher than that in MAP− controls (318 ± 57.2 nmol/mL vs. 289 ± 95.8 nmol/mL, P > 0.05). Consequently, mean calcium level in bovine MAP+ was significantly higher than that in bovine-MAP− samples (9.98 ± 0.998 mg/dL vs. 7.65 ± 2.12 mg/dL, P < 0.05). Also, the level of ucOC was higher in CD-MAP+ than in CD-MAP− (561 ± 23.7 nmol/mL vs. 285 ± 19.6 nmol/mL, P < 0.05). Interestingly, the mean osteocalcin level in MAP+ bovine was lower than that in MAP− bovine (797 ± 162 pg/mL vs. 1190 ± 43 pg/mL) and it was lower in CD-MAP+ than in CD-MAP− infection (1.89 ± 0.184 ng/mL vs. 2.19 ± 0.763 ng/mL) (P < 0.05). The correlation between MAP infection and elevation of sera ucOC, reduction of active osteocalcin and increased calcium supports MAP infection role in CD and complications with osteoporosis.

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Patients with Rheumatoid Arthritis in Clinical Remission Manifest Persistent Joint Inflammation on Histology and Imaging Studies

The Journal of Rheumatology ◽

10.3899/jrheum.140411 ◽

2014 ◽

Vol 41 (11) ◽

pp. 2153-2160 ◽

Cited By ~ 26

Author(s):

Allen Anandarajah ◽

Ralf Thiele ◽

Ellen Giampoli ◽

Johnny Monu ◽

Gwy-Suk Seo ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Clinical Remission ◽

Severe Disease ◽

Joint Inflammation ◽

Imaging Studies ◽

American College Of Rheumatology ◽

Remission Criteria ◽

Magnetic Resonance Imaging Mri ◽

Active Inflammation

Objective.The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology.Methods.We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined.Results.Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US.Conclusion.Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.

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Tu1988 Impact of the Commensal Bacterium Faecalibacterium prausnitzii in a Non Active Inflammation Murine Model

Gastroenterology ◽

10.1016/s0016-5085(13)63344-2 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-897-S-898 ◽

Cited By ~ 1

Author(s):

Rebeca Martin ◽

Florian Chain ◽

Jun Lu ◽

Jennifer Jury ◽

Jean Jacques Gratadoux ◽

...

Keyword(s):

Murine Model ◽

Commensal Bacterium ◽

Faecalibacterium Prausnitzii ◽

Active Inflammation

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Active inflammation and intestinal metaplasia at the cardia are not related to GORD

Gastroenterology ◽

10.1016/s0016-5085(08)82103-8 ◽

2001 ◽

Vol 120 (5) ◽

pp. A424

Author(s):

Umakant Dave ◽

Vicky Loh ◽

Julian Teare ◽

Mark R. Thursz ◽

Marjorie M. Walker

Keyword(s):

Intestinal Metaplasia ◽

Active Inflammation

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Influence of uveitis on Bruch’s membrane opening minimum rim width and retinal nerve fibre layer thickness measurements

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313016 ◽

2018 ◽

Vol 103 (10) ◽

pp. 1413-1417 ◽

Cited By ~ 3

Author(s):

Matthias F Kriegel ◽

Arnd Heiligenhaus ◽

Carsten Heinz

Keyword(s):

Layer Thickness ◽

Nerve Fibre ◽

Retinal Nerve Fibre Layer ◽

Bruch's Membrane ◽

Bruch’S Membrane ◽

Fibre Layer ◽

Bruch’S Membrane Opening ◽

Nerve Fibre Layer ◽

Active Inflammation ◽

The Impact

Background/aimsTo assess the impact of papillary leakage and active inflammation on optical coherence tomography (OCT)-based retinal nerve fibre layer thickness (RNFLT) and Bruch’s membrane opening minimum rim width (BMO-MRW) measurements in uveitic eyes with and without secondary glaucoma.MethodsProspective, single-centre analysis of patients with uveitis. All patients included received a fluorescein angiography examination and an OCT scan measuring the BMO-MRW and the RNFLT in three concentric peripapillary ring scans.ResultsOverall, 95 eyes of 56 patients were enrolled. Papillary leakage and active inflammation were present in 39 (41%) and 57 (60%) eyes, respectively. Twenty-one eyes were classified as glaucomatous; 10 of those glaucomatous eyes showed papillary leakage. Both BMO-MRW and RNFLT measurements were significantly increased in eyes with papillary leakage (BMO-MRW: p=0.0001; RNFLT: first to third ring (p<0.0001)). Active inflammation led to a significantly thickened RNFLT (first ring: p=0.0026; second ring: p=0.0009; third ring: p=0.0002) while only a trend towards increased values could be observed in the BMO-MRW measurements (p=0.3063). Glaucomatous eyes with papillary leakage demonstrated significantly higher values on both BMO-MRW and RNFLT measurements than glaucomatous eyes without leakage (BMO-MRW: p=0.0159; RNFLT: first ring: p=0.0062; second ring: p=0.0037; third ring: p=0.0197). No significant difference could be observed between glaucomatous eyes with leakage and non-glaucomatous eyes without leakage (BMO-MRW: p=0.4132; RNFLT: first ring: p=0.5412; second ring: p=0.3208; third ring: p=0.1164).ConclusionsThe OCT scanning parameters BMO-MRW and RNFLT were significantly influenced by papillary leakage in uveitic eyes with and without glaucoma. RNFLT values were also significantly increased while active inflammation was present. In patients with uveitis, these OCT-based imaging tools should be interpreted with caution, especially in those with papillary leakage or active inflammation.

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Clinimetric criteria of rheumatoid arthritis

Italian Journal of Medicine ◽

10.4081/itjm.2012.179 ◽

2012 ◽

Author(s):

Domenico Galasso ◽

Massimo L’Andolina ◽

Norma M. Marigliano ◽

Salvatore Galasso ◽

Giovanni Forte

Keyword(s):

Rheumatoid Arthritis ◽

Inflammatory Diseases ◽

Activity Index ◽

Functional Limitation ◽

Measurement Scale ◽

Systemic Autoimmune Disease ◽

Impact Measurement ◽

Related Quality ◽

Health Related ◽

Active Inflammation

Rheumatoid arthritis is a systemic autoimmune disease, mainly poli-artycular, among wide-spread chronic inflammatory diseases, that cause pain, functional limitation, damage and joints deformations, and disability. It is characterized by turns of active inflammation and remission phases. Inflammation degree and persistence are associated to a bad functional prognosis and progressive joint disability. These patients management require a continuous valuation of inflammatory activity index of disease both therapeutic management and to prevent disablement process. We focus on many valuation index of joint disability and functional damage. Very important are both the scales of auto-values concerning the pain and the joint swelling and clinical data get by physician to valuate activity index of disease as defined by DAS28. Significant data come by health-related quality of life, disability and by AIMS2 (Arthritis Impact Measurement Scale).

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